European Child & Adolescent Psychiatry最新文献

Background: Adolescence is a critical developmental period characterized by significant challenges, a time of "storm and stress". The complex system of multidimensional mental health problems may vary across early, middle, and late adolescence due to the distinctive developmental tasks. However, previous efforts to identify prevention and treatment targets mainly focused on limited aspects of such a system and lacked age-specific considerations.

Objective: This study aims to identify pivotal age-tailored treatment and prevention targets for multidimensional mental health problems through dynamic simulation.

Methods: Three stage-specific between-subject networks were constructed to model mental health problems, using data from 80,113 Chinese adolescents. In silico intervention was implemented on these networks to identify particular symptoms that, if targeted, would prove most effective in either preventing (via aggravating simulation) or treating (via alleviating simulation) mental health issues within the mental health system.

Results: Stage-specific in silico intervention analysis revealed that, during early adolescence, academic stress and interpersonal sensitivity were the most effective targets in aggravating and alleviating interventions, respectively. In middle and late adolescence, anxiety emerged as the most significant target for aggravation, while emotional disturbance demonstrated the greatest alleviating effect.

Conclusions and implications: Academic stress experienced during early adolescence and anxiety prevalent in middle to late adolescence are recommended as primary prevention targets. Interpersonal sensitivity emerges as the most effective treatment target for early adolescents, whereas emotional disturbance should be prioritized for middle to late adolescents.

Atypical error responses characterize pediatric anxiety disorders. Error responses are considerably influenced by situational factors such as social context, which typically elicits enhanced error responses. This study investigates the impact of social context on the neural correlates of error processing and how individual differences in anxiety symptoms and naturalistically-sampled daily worry influences these associations. Sixty-two youth (32 with an anxiety disorder, 30 healthy controls; M_age =13.9 +/- 2.7, 61% female) underwent functional magnetic resonance imaging while completing a flanker task in both peer and alone context. Anxiety symptoms were measured using Screen for Child Anxiety Related Disorders, and daily worry was measured using ecological momentary assessment. Diagnosis inclusions were only used to ensure enriched sample for symptoms dimensions of anxiety but not used as a grouping criteria. The presence of a simulated peer was associated with decreased activity in the precuneus, mid-orbital gyrus, and parahippocampal gyrus/amygdala during error processing. In youth with higher anxiety symptom severity, the presence of a peer was associated with decreased activity in the superior/middle temporal gyrus and middle frontal gyrus. In contrast, for youth rating higher levels of daily worries, the presence of a peer was associated with increased activity in the inferior frontal gyrus and middle cingulate cortex. Findings highlight the importance of social context in error processing. Results further suggest that anxiety and worry differentially modulate neural responses in the presence of a peer.

Emotion regulation (ER) is a relevant transdiagnostic mechanism for mental health, involving cognitive, behavioral, and physiological processes. Children of parents with a mental illness (COPMI) are at increased risk for ER difficulties, yet the integration of state and trait ER assessments remains underexplored. This study employs a multimodal approach to assess ER in COPMI compared to children of parents without a mental illness (COPWMI). We examined trait ER via self-report in 195 children (96 COPMI/99 COPWMI) aged 4 - 16, cognitive state ER using an emotional Go/Nogo task in 243 children (96 COPMI/147 COPWMI) aged 7 - 16, and physiological state ER through heart rate and electrodermal activity responses during an emotional video task in 124 children (49 COPMI/75 COPWMI) aged 7 - 16. No significant group differences emerged in cognitive or physiological measures of state ER. Emotional stimuli affected physiological responses across all participants, but COPMI did not show heightened reactivity or diminished affective inhibitory control compared to COPWMI. Furthermore, trait ER did not significantly predict state ER responses across groups. These findings challenge the assumption of broad ER impairments in COPMI and highlight the importance of considering situational and environmental factors when assessing ER. The absence of universal state ER deficits suggests that some COPMI may compensate for potential vulnerabilities.

Globally in 2021, about 1 in 4 children and young people (CYP) below age 25 lived with poor mental health. Various forms of digital health interventions (DHIs) have been introduced in attempts to address unmet mental healthcare needs among young people. DHIs use websites or applications in computers, tablets, or smartphones to deliver mental health interventions, which are either self-directed, or therapist guided. This rapid review synthesises the evidence on the cost-effectiveness of DHIs for supporting mental health in CYP. A literature search was carried out in MEDLINE and PsycINFO using Ovid platform. The search was restricted to peer-reviewed studies published in English between Jan 2018 to May 2025. Eligible studies were identified using the population, intervention, comparator, outcome, and study design (PICOS) framework. Studies were eligible for inclusion if they provided a trial- or model-based full economic evaluation or return on investment of a DHI targeting mental health in CYP up to 25 years of age. Titles and abstracts of 1,265 records were screened. 15 studies met the criteria for inclusion following full-text screening of 28 studies. The focal outcomes in the studies included reduction in symptoms linked to depression, anxiety, and alcohol use. Most studies evaluated computerised cognitive behaviour therapy (CBT) or interventions that included aspects of CBT as the primary intervention. All studies except two reported the DHIs to be cost-effective, at least under certain conditions. Two model-based and three trial-based studies reported that the interventions were dominant (cost saving and more effective) with respect to at least one outcome measure. There is some evidence to suggest DHIs hold the potential to expand and extend mental health support for CYP with minimal therapist involvement. Yet, the evidence is not conclusive due to short follow-up periods, variability in the methodological approaches and reporting of results. High quality evidence on cost-effectiveness of DHIs with comparable methodological approaches is needed to inform implementation decisions.